Healthcare Provider Details

I. General information

NPI: 1669838579
Provider Name (Legal Business Name): VALLEY DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 N. SHENANDOAH AVE. 1
FRONT ROYAL VA
22630
US

IV. Provider business mailing address

840 N. SHENANDOAH AVE #1
FRONT ROYAL VA
22630
US

V. Phone/Fax

Practice location:
  • Phone: 540-631-1515
  • Fax: 540-431-2728
Mailing address:
  • Phone: 540-631-1515
  • Fax: 540-431-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0401413285
License Number StateVA

VIII. Authorized Official

Name: AYMAN K ADEEB
Title or Position: OWNER
Credential: DDS
Phone: 540-631-1515